{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SAUNDRA D CARTER","gend":1,"add":"2648 PRICE CREEK ROAD","city":"FARMVILLE","state":"VA","zip":239019999,"dob":"1945-08-13","age":"","mstatus":"","insh":11014619,"cliId":"2VU3VV7TJ91","pno":4343151599,"cno":"","email":"","ename":"","eno":"","pphy":"ADANIEL, VICTOR R","ppno":4343929438,"pcpadd":"1166 Kennedy Blvd","pcpcity":"Bayonne","pcpstate":"NJ","pcpzip":70023112,"pcpcounty":"","pcpid":"P0149906","pcpname":"SOUTHSIDE MEDICAL PRACTICE","plan":"VPHP - VIRGINIA PREMIER","program":"Medicare","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R94.31","K41.90","Z71.89","Z71.3","I73.9","N81.84","N39.46","N39.41","G89.29","N32.89","C67.9","R30.0","N39.0","Z23","F32.9","S32.9XXA","Z91.040","C67.8","Z85.51","S52.501A","M25.531","W06.XXXA","S52.611A","M19.90","I25.10","Z86.73","E78.00","I12.9","Z72.0","N18.30","M79.641","Z01.810","I70.209","I10","I63.9","E78.5","I72.4","F17.200","Z20.828","R00.1","S52.591A","Y93.9","G62.9","Z82.49","Z88.5","Z88.8","Z79.899","S69.91XA","T83.091A","Y73.2","Z98.890","F17.210","S62.101A","R07.9","J98.4","I25.2","J44.9","Z95.5","R06.02","R10.9","I70.0","R60.1","R93.2","N28.1","I77.811","R91.8"],"date":["2020-07-01","2020-07-13","2021-01-11","2021-01-11","2020-11-17","2021-01-24","2021-01-24","2021-01-24","2021-01-24","2021-01-24","2021-02-02","2020-09-15","2020-12-31","2020-09-15","2020-11-16","2021-02-03","2020-12-31","2020-09-29","2020-11-28","2020-11-11","2020-11-09","2020-11-17","2020-11-09","2020-12-31","2020-12-31","2020-12-31","2020-12-31","2020-12-31","2020-11-09","2020-12-31","2020-11-09","2020-11-12","2020-11-16","2020-11-16","2020-11-16","2020-11-16","2020-11-16","2020-11-16","2020-11-16","2020-11-16","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2020-12-31","2020-11-17","2020-11-28","2020-11-28","2020-11-28","2020-12-31","2020-12-02","2021-02-12","2021-02-12","2020-11-16","2020-11-16","2020-11-16","2020-12-31","2020-12-31","2020-12-31","2020-12-31","2020-12-31","2020-12-31","2020-12-31","2020-12-31"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}